How better-targeted technologies can fix the mess of emergency medical care

Elderly people and veterans are among the chronically neglected when it comes to American medicine. We know who these people are, so why do they still die alone in their homes?

Why do at-risk former warfighters go without potentially lifesaving mental healthcare? Why did an 87-year-old lady suffer a heart attack at a nursing home in Bakersfield, California — and even after she died, why was it unclear whether she wanted to be resuscitated?

Why don’t we look up patients’ clinical details in the field, leveraging technology for insight about such basic decisions as whether or not to apply paddles to the chest or insert a breathing tube?

We know who belongs to the most under-served groups, and through technology (as well as old-school follow-up care) we can keep track of them. We can make advance directives available in an instant, where and when people suffer critical emergencies. Why don’t we?

We can, and should, debate national identification numbers. What we should not debate is whether solutions that can bring the healthcare system in line with our expectations — that it is smart, connected, open, equitable, and committed to our well being — are worth cultivating from both technological and financial (read: investment) sides.

The Bakersfield tragedy seemed like an extraordinary event, but it was far from being one. The public’s naivete was the tragedy here, for while ignorance may be bliss, it is also very dangerous and wildly expensive. I work in the emergency medical services business, and I can tell you that if I had a nickel for every time someone expressed shock that today’s EMS, fire, police and other public safety organizations rarely rely on integrated systems that move data seamlessly from a 9–1–1 call to dispatch to field provider to receiving hospital, my startup wouldn’t need funding!

To the contrary, few areas of public infrastructure other than Emergency Medical Services — especially those deemed critical and integral to the soundtrack of city life — still see the “state of the art” as paper and a clipboard. The reasons for this go beyond the scope of this essay, but they should spark outrage all the same: innovation is infrequently demanded in the emergency services market, and when it does comes through it often takes the shape of an unfunded mandate created by medical directors for medical directors, divorced from technology best practices (and not necessarily considerate of the field-use needs of EMS professionals).

Or worse, public demands for “innovation” lead bureaucrats to draft Requests for Proposal seeking every feature under the sun…without a budget to pay for them … and even with technical features that conflict or are impossible. (Case in point: I have seen EMS agencies ask for iOS applications they can run on a Panasonic Tough book PC.)

The state of emergency medical services in 21stcentury America is labyrinthine, from low-bid technology stalwarts who haven’t innovated in a decade to crisscrossed regulations at every level of government to a simple lack of choice — Do you know who your local ambulance provider is? At the end of the day, few legislators or integrated hospitals want to take responsibility for what long-serving medics themselves frequently call the “bastard stepchild of the healthcare system.” (That such a moniker may be bestowed on such sacred work reflects the public’s perception but breaks my heart.) Ambulance services therefore must fend for themselves and often languish.

Americans widely believe that EMS works the same across the country, which isn’t necessarily true. There’s much variation in the form and structure of emergency services across the country, based on politics, weather, and even terrain. What everyone neglects to note is that EMS is not compensated like the rest of the medical establishment. Ambulance agencies cannot submit for reimbursement with billing codes for treatments performed, and they are required by a very powerful federal law called EMTALA to provide care whether or not their patients are willing to pay. Moreover, Medicare makes ambulances bill by the mile, like souped-up taxis charged with patients’ survival, even though EMS agencies are at least as exposed as other caregivers (if not more so, given what they do all day) to liability in the case of a patient’s death or morbidity.

With so much complexity, the emergency medical services industry forms its own barrier to entry, but we can leverage solutions from other industries to bring insight to the field. For example, using a patient’s Social Security Number to aggregate health data including so-called Advanced Directives (such as Do Not Resuscitate orders), then making those available to EMS providers arriving on scene-like a prehospital Health Information Exchange. My own firm has developed interfaces inspired by analogues from online banking to Android phones.

This highlights the good news: those of us who smash through the health industry’s barriers do so armed with disruptive innovations and business-case justifications, plus a cohort of customers that is literally starving for something new and different. EMS providers that can’t bill for new technologies need a reason to buy in the absence of a mandate. They’re willing and ready to listen, if but someone would speak to them in actionable language. (In the case of my firm’s MEDIVIEW™ software platform, we’re the first to leverage the triumvirate of telemedicine, online-offline GPS, and a SaaS portal for near-real-time access to pre-hospital data as a trio of methods to help EMS agencies “connect the dots” from the field to the hospital, cut operating and overtime cost, and speed completion and movement of pre-hospital patient data into the receiving care facility.)

Yet where people — especially the indigent — don’t pay for ambulance services, EMS providers struggle to pay for innovations that can enhance both patient care and operational efficiency. Much technology therefore stays on the shelf, away from the people and places it could most immediately help. This paradox of healthcare IT has led to “clustering” around well-worn, less-desperate problems.

Originally published at on April 3, 2013.

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